Background Global 12-month psychosis prevalence is estimated at roughly 0.4%, although prevalence of antipsychotic use in the U.S. is estimated at roughly 1.7%. Antipsychotics are frequently prescribed for off label uses, but have also been shown to carry risk factors for certain comorbid conditions and with other prescription medications. The study aims to describe the socio-demographic and health characteristics of U.S. adults taking prescription antipsychotic medications, and to better understand the association of antipsychotic medications and comorbid chronic diseases. Methods The study pools 2013–2018 data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey of non-institutionalized U.S. residents (n = 17,691). Survey staff record prescription medications taken within the past 30 days for each respondent, from which typical and atypical antipsychotic medications were identified. Results Prevalence of antipsychotic use among U.S. adults was 1.6% (n = 320). Over 90% of individuals taking antipsychotics reported having health insurance and a usual place for care, significantly more than their counterparts not taking antipsychotics. Further, those taking antipsychotics reported higher prevalence of comorbid chronic diseases and took an average of 2.3 prescription medications more than individuals not taking antipsychotics. Individuals taking antipsychotics were more likely to sleep 9 or more hours per night, be a current smoker, and have a body mass index greater than 30 kg/m2. Conclusions U.S. adults who take antipsychotic medications report more consistent health care access and higher prevalence of comorbid chronic diseases compared to those not taking antipsychotics. The higher comorbidity prevalence and number of total prescriptions highlight the need for careful assessment and monitoring of existing comorbidities and potential drug-drug interactions among adults taking antipsychotics in the U.S.
Objective To date, there are no FDA approved medications for treatment of early COVID-19 infection. Recently, use of melatonin, a naturally occurring tryptophan-derivative synthesized in the pineal gland and immune cells, has been suggested as an early treatment option for COVID-19. Melatonin has known anti-inflammatory, immunomodulatory, and protective antioxidant mechanisms that may attenuate the severity of COVID-19 symptoms. The objective of the present narrative review is to discuss the use of melatonin as an early treatment option on the first day of diagnosis for COVID-19. Methods The MeSH terms “COVID-19” and “viral diseases” were manually searched on PubMed and relevant articles were included. Results Results showed that melatonin acts to reduce reactive-oxygen-species mediated damage, cytokine-induced inflammation, and lymphopenia in viral diseases similar to COVID-19. Conclusions These conclusions provide evidence for potential benefits in melatonin use for COVID-19 treatment as early as the day of diagnosis.
Good skin integrity is vital to good health because the skin acts as a barrier to microbes and toxins, as well as physical stressors such as sunlight and radiation. It is well known that the skin loses integrity with the ageing process, and this makes older adults susceptible to pressure injury. Additionally, older skin takes longer to heal where there are injuries or breaks. This article looks at what skin integrity is by briefly outlining the physiology of the skin. It discusses how skin integrity can be impaired, what can be done to maintain skin integrity and skin health, and why skin integrity is important for pressure ulcer prevention. Some of the factors that can make skin care difficult are discussed, in addition to the role of community nurses in helping patients engage in skin care. The article outlines how community nurses can identify when there is skin integrity risk or damage and support patients and carers or relatives, in maintaining skin integrity.
Hepatic epithelioid hemangioendothelioma (HEH) is extremely rare, occurring in 1 to 2 per 100,000, with chemotherapy options not well defined. Our case involved a 49-year-old female who had hepatic masses and metastasis to the lungs with a liver biopsy revealing HEH. After developing a rash from sorafenib, thalidomide was started with the progression of disease stabilized. Resection is only an option in 10% of the cases; therefore, chemotherapy is the only line of treatment. Newer chemotherapy alternatives are targeting angiogenesis via the vascular endothelial growth factor. Thalidomide was first used as an antiemetic, but, sadly, soon linked to phocomelia birth defects. Given the mechanism of action against angiogenesis, thalidomide has a valid role in vascular tumors. In conclusion, the use of thalidomide as chemotherapy is novel and promising, especially in the setting of a rare vascular liver tumor such as HEH.
ImportanceAlthough the increased risk of obesity among individuals with autism has been well established, evidence on the association between autism, cardiometabolic disorders, and obesity remains inconclusive.ObjectiveTo examine the association between autism spectrum disorders and cardiometabolic diseases in a systematic review and meta-analysis.Data SourcesPubMed, Scopus, Web of Science, ProQuest, Embase, and Ovid databases were searched from inception through July 31, 2022, without restrictions on date of publication or language.Study SelectionObservational or baseline data of interventional studies reporting the prevalence of cardiometabolic risk factors (ie, diabetes, hypertension, dyslipidemia, atherosclerotic macrovascular disease) among children and/or adults with autism and matched with participants without autism were included.Data Extraction and SynthesisScreening, data extraction, and quality assessment were performed independently by at least 2 researchers. DerSimonian-Laird random-effects meta-analyses were performed using the meta package in R.Main Outcomes and MeasuresRelative risks (RRs) of diabetes, hypertension, dyslipidemia, and atherosclerotic macrovascular disease among individuals with autism were the primary outcomes. Secondary outcomes included the RR of type 1 and type 2 diabetes, heart disease, stroke, and peripheral vascular disease.ResultsA total of 34 studies were evaluated and included 276 173 participants with autism and 7 733 306 participants without autism (mean [range] age, 31.2 [3.8-72.8] years; pooled proportion [range] of female individuals, 47% [0-66%]). Autism was associated with greater risks of developing diabetes overall (RR, 1.57; 95% CI, 1.23-2.01; 20 studies), type 1 diabetes (RR, 1.64; 95% CI, 1.06-2.54; 6 studies), and type 2 diabetes (RR, 2.47; 95% CI, 1.30-4.70; 3 studies). Autism was also associated with increased risks of dyslipidemia (RR, 1.69; 95% CI, 1.20-2.40; 7 studies) and heart disease (RR, 1.46; 95% CI, 1.42-1.50; 3 studies). Yet, there was no significantly associated increased risk of hypertension and stroke with autism (RR, 1.22; 95% CI, 0.98-1.52; 12 studies; and RR, 1.19; 95% CI, 0.63-2.24; 4 studies, respectively). Meta-regression analyses revealed that children with autism were at a greater associated risk of developing diabetes and hypertension compared with adults. High between-study heterogeneity was a concern for several meta-analyses.Conclusions and RelevanceResults suggest that the associated increased risk of cardiometabolic diseases should prompt clinicians to vigilantly monitor individuals with autism for potential contributors, signs of cardiometabolic disease, and their complications.
Electronic cigarettes (e-cigarettes) are an increasingly popular source of nicotine and an increasingly popular topic in the media. Concerns about potential hazards associated with e-cigarette use and advertising, especially to adolescents, have led to studies on e-cigarettes in both traditional media (TV, mail, print, and outdoor advertising) and social media (websites, social networking sites, blogs, and e-mails). This review presents a narrative description of available studies related to e-cigarettes in the media. These articles have focused on promotion in both traditional and social media across a broad range of topics and have concentrated on target audiences, smoking cessation, harm reduction, and advertising. E-cigarette advertising is the most frequent topic in the published articles. Identifying the target audience also is a common objective in articles. The representation of e-cigarettes as a "healthier alternative" to traditional cigarettes and their use as a "smoking cessation aid" are main themes presented through all types of media.
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